Ask Laura

Great question! First, let me say CONGRATULATIONS! I am glad you realize how important online reviews are to the practice.

People are looking online for help with making decisions about everything from restaurants to healthcare providers. So, it only makes sense that dental offices have an online presence as well.

Patients are judging us, but probably now how you think. They are judging us not on the clinical skills of the doctor but on how they FEEL when they are on the phone with us or with us face to face in the office. They want to feel comfortable, cared for and heard. They want to know we are going to do our best to help them.
Every person on the team should be prepared to ask a patient for a review. If a patient says something, anything, positive about their experience -that is your chance. “Thank you so much for that compliment! We would love to share that with other people. Would you be willing to provide an online review for us?”. Most patients will say yes, of course, they will, and forget as soon as they exit the building.

A few tips about asking for reviews and making sure patients follow through:

1. Remind patients of your online presence – email blasts, confirmation messages, your voicemail message – are all ways to get the word out.
2. Send a link to via email or text immediately after their appointment thanking them for reviewing the practice. 3. Any positive comment – “That was so easy!”, “Thanks for getting me in today”, “The lady on the phone was so friendly!” – Should be followed by a thank you and a request.

Good luck and shoot for 5 stars with each and every patient!

QUESTION: My front desk team is having a hard time scheduling new patients right now because we are booked out so far.  What can they say to these patients?

ANSWER: Typically, we like to get new patients in as soon as possible. This is because we want to let them know we are here to help and also because we know something has motivated them to call in that moment and we need to take advantage of that before they change their mind.

If you have a situation where your schedule does not allow for new patient visits in the near future, I do have a few tips;

1. Ask questions.  Some people may call and say they need a cleaning but, is that really what they need?  Ask them- are you having any issues at the moment? Are you experiencing any discomfort?  This allows you to assess the situation and decide if they need to come in sooner.

2. Let patients know you will be happy to reach out if there is a change in your schedule that will allow them to come in sooner.  A “change” vs a “cancellation”.  Why? Because if we tell patients cancellations are typical they will think missing or cancelling an appointment is no big deal.  And that is NOT what we want them to think.  We want them to value their time with us and understand the importance of keeping appointments.

3. Consider “tweaking” your new patient protocol.  If you remove some of the restrictions with new patient appointments you may be able to get someone in sooner.  For example, some offices require  90 minutes for a new patient visit in the hygienist schedule.  Well, what if we tried 60 minutes in the hygiene schedule and 30 minutes in the doctor’s schedule? Be open to alternate ways to schedule a new patient.

At the end of the day we want to get those patients in ASAP. The longer they have to wait the more likely they will either go to another provider, or not show up for the appointment you gave them in your office.

QUESTION: I have filed a claim with Delta Dental for an impacted wisdom tooth and they denied it because they want myself, the dentist, to file a claim with medical first. I have never filed a medical claim and I am not what necessary steps need to be taken. Please help!

ANSWER:

To begin:

1. Reach out to the patient and ask them for their medical insurance card.

2. Call the medical insurance and ask if they will pay for the treatment that has been completed (ie: wisdom tooth extraction)? Do you need a pre-authorization? Make sure to keep detailed information on who you spoke to, date and time, phone numbers, along with claim information.

3. If YES, ask if you can bill them on a dental claim form and ask for a fax to send it to someone directly. Keep a confirmation page that it was sent.

4. If they say NO, ask the best way to get a denial to use for the dental plan.

To find codes:

Free 2021 ICD-10-CM Codes

Subscribe to Find-A-Code

Sample of a diagnosis code:

• K01.1  is the ICD Diagnosis code
• Since there is no specific CPT code for reporting the removal of impacted teeth, simply report the appropriate dental code in box 24D of the CMS-1500 medical claim form. If the carrier does not accept HCPCS codes, then report CPT 41899 and include a brief narrative describing the procedure performed.

Proprietary. *Information from ICD10data website

QUESTION: My front desk team is spending too much time on the phone with patients.  They get involved in long conversations that do not go anywhere.  How do I teach them to cut back on the “chit chat” and get people scheduled!

ANSWER: Great question!  We all want to provide excellent service and take care of people as best as we can.  Sometimes, we allow callers to dominate conversations because we think we need to answer every question they ask.  Good news here is – we don’t need to do that!  When someone calls your office something has motivated them to call in that moment and we need to find out what they need and get them scheduled.   This is not the time to go into details about insurance plans or how dental insurance operates or a cost comparison of  crown vs an inlay.  This is your chance to build rapport, and help the patient.  The best way to help?  Get them an appointment!  

When we start answering questions and giving too much information, we get off track.  We lose sight of the goal.  Sometimes this can end with a patient being overwhelmed or just out of time and they do not book an appointment.

We can answer questions when patients come in and we are face to face.  That is a better environment for explanations and patients will have a clearer understanding of the information you are sharing.

“I am so glad you called Mrs. Smith!  As far as what your insurance plan covers I will be happy to find out when we verify your coverage.  For now, the best way for us to help you is to get you in the schedule to see the doctor and we can answer all of your other questions when you come in for that appointment”.

Role playing will help your team with better communication!

Great question!  The intention of office systems and protocols is to create efficiency, consistency and flow in the office.  What I have found is that systems are created but no one is properly trained on those systems.  So, each team member has a different way of completing tasks.   Which creates confusion.

How to fix this?  Do an audit of your systems.  Update what you have already and create new protocols where they may be needed.  Next, communicate with the team.  Make sure everyone understands the expectations and that adhering to them is necessary.

Is someone not “catching on”?  They may need individual help.  The entire team needs to be consistent in order for you to provide top notch customer service to each and every patient.

Question: I have just hired a new team member.  She is young, this is her first “real” job and I am concerned that her lack of experience is reflected in how she communicates with people. What can I do to help her speak more professionally?

Answer: You have taken the first step by recognizing that you need help!  Setting a new team member up for success is so important and the best way to do that is with training.  Make sure there is an understanding of  what you expect and work on verbal skills through role playing.  Also, explain that your patients are the heart of your practice and caring for them and making them comfortable is your main goal.  Keeping communication positive is part of the process and that is a skill some people will need help with.  Practice! Practice! Practice! Is what creates confidence and allows team members to communicate well.

Even the most experienced and educated employees still require training when they join your company. Maybe they just need to learn about the company culture or review the procedures your office uses. For employees and employers, on-the-job training is the best way to get up and running in the most efficient and effective way possible.

QUESTION: Laura mentioned outsourcing A/R and using a collections agency if needed. She talked about interviewing the companies. What would we ask and what’s important to know?

ANSWER: I recommend outsourcing things like Insurance Verification and Accounts Receivable when it makes sense for your practice. I think it’s much more important for your team to focus on the patients and exceptional customer service than sitting on the phone for hours with insurance companies or chasing down past due accounts. When it comes to a collections agency, there are many companies that are experts in this area and I highly recommend reaching out and interviewing them first to find out if they are the right fit for you and your practice.

Here are a few questions I would consider asking:

• Are you licensed in all 50 states?
• How do you train your collectors?
• How much will your services cost me? (ie. percentage of collections, flat rate per account, etc.)
• Do you work with my type of business or what is your experience/expertise in my type of business? (ie. do you work in dental)
• What will be your expectations from me?
• How will my patients be treated by your collectors?
• How will I be updated on the status of my accounts?
• What sets you apart from other collections agencies?

Remember, we provide the best care and exceptional customer service to our patients and we want to be paid for our services so keeping a good account of your receivables & collections is very important and working with a company that can help you achieve both is ultimately the best for you and your patients.

Question: If you have an employee, who steps away too many times from the desk for snacks and bathroom breaks, how would you suggest to address this matter? How many times is too many?

Question: Our schedule is full right now but we expect to have an empty hygiene schedule in a few months. What do we do?

QUESTION: We are wanting to offer some payment plans for our patients. I am looking more for an agreement that we can have the patient sign. How can we best track these in-house specifically….we are splitting payment up between 2+ payments and we want to have that documented.

ANSWER: During the treatment presentation you can print out the treatment plan and use that for any notes during the conversation.  That includes financial discussions.  If you decide to allow the patient to break up the payments, make note of it on the treatment plan that you have printed out and once the patient has agreed, have them sign the plan.  Then make a copy for them and keep a copy for the chart, and add notes to the patient account. When a patient signs the treatment plan or a payment agreement form, it is confirmation of them understanding what has been explained and an agreement to pay what was discussed.

As far as keeping track of the payments, that is something the dental software can do.  Depending on what type of software you have, there are different methods to set up multiple payments in a patient account. I recommend contacting your dental software support on the specifics on how you are able to do this.

Additionally, please see the example of verbal skills to confirm the patients payment once they are ready to schedule their appointment, whether they are in the consult room or scheduling by phone. It is important to know ahead of time of their appointment on how they would like to handle their payment so they are not surprised when they come in for an appointment. Also, you will have the payment agreement form available to show the patient that they agreed and understood the cost of their treatment plan.

Make sure to ALWAYS take good notes in the patient’s chart so this way ALL team members are able to answer the question in the same manner, so no patient is upset when receiving different information from each team member.

QUESTION: What is everyone doing with clinical staff coming up to the front area? We have extra computers for them to work on and they have lab slips up here.

ANSWER:

I believe right now, there should be a clearly defined clinical and non-clinical area.  Everything clinical team members need to complete their jobs should be in the clinical area (computers, routing slips, lab case information etc.). Cross contamination is a real concern.  We are telling patients how important it is for them to adhere to new protocols, so we need to be sure our team members are doing so as well.

Question:

There was and is a lack of management and direction in the front office. So I am looking to help them create more structure and be more systematic. How can this be done?

Answer: Our team members today are very different than in the past. They are very diverse in many ways as we have Gen X’s and now Gen Y’s and still many Millenials. Many are well educated and understand the digital age we live in and work well together, while some still have challenges. While we face new challenges in our current climate and with different generations, etc., the success of our team members still relies on a core set of basics for success and structure. Although our teams face an ever growing set of challenges, there are a few key factors that managers can focus on to help their teams succeed.

The first key to creating a great team is having a shared mindset. Helping them understand your WHY, their WHY and the overall practice WHY will help create engaged and inspired teams that will help them and you reach your goals. Once they understand the why behind the goals, they will care more about it, whether it’s for increased pay or promotion or a feeling of accomplishment.

Second, high performing teams have team members with a balance of skills, so teams need to have set structure for continual training and cross-training. Providing the team with the proper support will enable the teams efficiency and effectiveness. Teams need access to the tools to perform their specific job duties, a training platform for learning those duties and a good system that reinforces good performance.

There are multiple ways team leaders can actively encourage and create a structured and systematic team and ensure that each team member feels valued and appreciated for their contribution to the team. Below are some resources that we have available for daily duties of each front office staff position within a dental office. I have also included a good read that will be a helpful foundation when delegating these positions to your staff. Take a moment to chat with your team members and see who’s skills & personality fit with the position, what they like to do and if you feel they will best contribute to that position in the practice. If you have a part time team member, these positions can be shared as well, as long as there is great communication skills within the office with those who may share a position/ daily tasks and they are afforded the training opportunities to do the job well.

Additionally, be sure you have job descriptions for each position and that it covers the duties they are expected to do. We offer those on the site as well under our documents section and they can easily be found by using the search option for job descriptions. Lastly, be sure to have regular team meetings & individual meetings with them to check in and make sure they have what they need to succeed.

Q: How many patients does Front Office Rocks recommend for a healthy 1 doctor & 3 hygienist practice?

We currently have 3314 active patients who have been in our office in the past year and a half. The staff has been killing themselves for 2 years so we are thinking about dropping some insurance but we want to evaluate how many patients we need to stay healthy.

Answer: 

Keeping track of the number of active patients is key to a successful, thriving dental practice. We all want that perfect number, but sometimes we don’t understand what keeps us at that balance. It’s important for doctors and team members to understand what makes their practice grow but first we must always start with the why – your patients.

Also, understanding what “active patients” are is the next question. The active patient count is the number of patients seen in your practice during a specified period of time. Our recommendation is patients seen anywhere from 12-18 months prior. The reason behind this is that it means you have a healthy recare system in place and are getting & keeping patients in the schedule and keeping the back door problem shut. Additionally, when you have patients who regularly reschedule, you don’t have to invest as much time, effort and money into new patients each month. You need to know your true numbers before you can make decisions on adjusting them.

Keeping your active patients truly active requires having a system in place and active effort from your team to make sure patients are not falling out of the schedule. The most important of these is making sure they reschedule their next recare appointment before they leave the practice. If you have a large number of active patients in the practice but are not seeing enough patients a day, it’s most likely the result of a scheduling issue. Be sure your team is investing time in training on productive scheduling.

So, what is the recommended number of patients to dentist ratio? Let’s look at a scenario. An active patient is seen about every 6 months/24 weeks. If your hygienist is working 5 days/week with an average of 8 patients a day, they will see about 40 patients per week. If we multiply the 40 patients per week by 24 weeks, that would be 960 patients. This means that the ideal scenario is approximately 1000 active patients: one dentist with two treatment rooms and one hygienist.

When practices try to see more patients in the same amount of time, they are working harder for less production and they usually find a decrease in the average annual billing per patient. In most cases, the more patients you have on the schedule, the less time and therefore, less attention you have for your patients. With additional hygienists, that also increases the number of hygiene patients to check, which allows you even less time to spend with patients in your operatories.

I also have included two options below for insurance negotiation that might help with the process of negotiation as well as deciding how much you are writing off and if it is worth staying in-network.

Unitas offers a revenue assessment and you can schedule a complimentary consultation with them directly. I have also included a direct contact below:
Bailey Malolo
Sales Coordinator
Unitas PPO Solutions
4140 E. Baseline Road, Suite 101, Mesa, AZ, 85206
office: (480) 525-8221, (800) 298-4222

Another company we also refer to is Profitable PPO’s. I have attached some resources they offer and included their contact information below.
Clint Johnson
Founder
Profitable PPOs
855-PPO-Gain
21640 North 19th Avenue, Suite C-102, Phoenix, AZ 85027
[email protected]

Please reach out to them and let them know you were referred by Front Office Rocks. And please don’t hesitate to reach out to me if you have any additional questions or we can help in any way.

Question: What should I have staff do during this down time? The office is slow staff has done a lot of cleanup of supplies and rooms already.

Answer: If your team has opportunities (I don’t like using the word down time) available during the day and you feel all rooms and areas of the office are stocked, cleaned and ready for patient care. Your team can sit down and focus on overdue recare patients and making phone calls to get those patients back on the schedule. They can also work on outstanding treatment on patients and making those phone calls to fill your schedule. If patients aren’t scheduling get them back for a second consultation to find out what is keeping them from scheduling. Look ahead to future scheduled patients and see if they can come to availability in the schedule.

Availability in the day is also a great opportunity for training and working on systems in the practice to help you grow.

Question: We have an in-house membership discount plan for patients without insurance where the patient pays $400 per year to get 2 cleanings, exams, etc. and 10% off dental work. We need to create a fee schedule for this plan so our books aren’t all out of whack. As of now, when person pays their annual fee, there is a big credit on their account until they use up all their benefits. So we need a way to zero out that annual fee so it doesn’t keep showing up. How would you recommend setting up a fee schedule for this?

Example: So just to be clear, let’s say patient X comes in to pay their annual fee and while they are there they get a cleaning, have an exam, and get fluoride. When we enter those procedures in the ledger they have set fees attached to them. So after their visit, if they paid $400 for the membership fee, maybe they only used $300 in services once we add them to the ledger. So they have a $100 credit on their account that won’t be reconciled until their next appointment likely 6 months later. Then at that next appointment, let’s say they get another cleaning and an exam and have some xrays so they have a $200 balance, which right now we enter as a patient courtesy credit for $200 and then their account is at zero. So you see how this really messes up our books?!? Any help you can give us would be appreciated!

Answer: Consider setting up a Membership code in your dental software for the annual membership fee.  This code is unique to your practice and is used to track your membership enrollments.  When the patient pays for the membership it will get applied to the code set up in your system so that your AR remains accounted for.

Next, Set up an insurance group with your membership plan name.  Then you can attach the fee schedule to that plan and you can put that the plan covers 100% of preventative codes, etc… That way you can easily identify that patient is part of the Membership Group.  Change the Insurance group to not take assignment of benefits and to not generate claims so it does not land on your outstanding insurance claim report.

If you need assistance with setting this up within your software we recommend reaching out your dental software support.  They can give the step by step specifics to your software.  By setting up the Membership Plan in your software this way it helps keep your ledgers clean, clear and accounted for.

Question: When calling a patient to confirm their appointment, what should I be saying?

Answer from Coach Missy: Even before the pandemic, we had specific skills we used when confirming appointments -the  type of appointment scheduled, repeating the date and time at least twice – just to name a few.  It is important to remember the why behind confirmation calls. We are not just reminding patients of their appointment, we are doing everything we can to make sure they SHOW UP for the appointment. #buttsinthechair

Due to the current pandemic and all of the uncertainty it brings, patients will have questions and concerns that need to be addressed and teams should prepare to answer those in a helpful, appropriate and consistent way.

Each office is different but in every office the check in/check out process will look different than it has in the past.   Your team needs to send a consistent message to patients about how the new process will work, and this includes explanation of:

Arrival/Check in – Will they text from the car?  Will they wait outside the door?  Will a team member escort them in?

Once inside – Will they stop at the front desk?  Will they go straight back to the operatory? Are you asking patients to handle payment & scheduling next appointments prior to going back to the operatory?

When treatment is complete – Will they exit the same way they entered?  Will they stop at the front desk or will check-out be handled in the operatory?  Has payment been handled? Did they schedule their next appointment prior to going back or in the operatory at the end of the appointment?

One new concern is going to be safety and infection control.  Patients want reassurance that you are following the necessary protocols so they feel comfortable coming to the office.  “Our main concern has always been the health and safety of our patients and our team members. As always, we continue to maintain the highest standards of sterilization and are following all of the guidelines as set forth by the ADA and our state dental association along with the CDC and other experts.” We do not need to go into deep detail about disinfection but we are letting patients know we are current with the standards and are staying up to date on any changes.

Another question patients may ask is “How long will my appointment take?”. Honesty is the best policy with this.  “We will do our best to treat you in an efficient manner.  We are all still getting used to the changes we have implemented.  If the appointment takes a few minutes longer than expected, it is due to the fact that we are doing everything we can to make sure you are safe.”  Managing patient expectations is important.  I would rather let patients know we may run behind than have an upset or confused patient.

As time goes on, there may be other concerns patients may have.  My advice is always to be honest and up front and let them know you are doing everything you can to keep them safe and healthy.   If you are not sure about an answer – let them know that. This is an uncertain time for everyone. “Our doctor and our team are continuing to learn about new protocols as they become available and we are always working to continually maintain a safe environment for our office team as well as our patients.”

This may seem like a lot to cover in the confirmation call,  but the more information the patients have in advance, the better. We are expecting them to follow an entirely new set of “guidelines”.  Offering details prior to their appointment will  help alleviate fears and help with the flow of the appointment.

QUESTION: Help! I am a doctor and I am afraid to ask my employee how she feels about certain things at our office, and with her job honestly, because I am afraid of what she will say.  How do you suggest I have this conversation?

ANSWER:

I am not a worrier.  I am not sure if that is a good thing or not, but I don’t play scenarios through my head over and over.  I don’t worry about conversations that I need to have with others often.  I don’t stress over what people might say or think when I talk to them.  Like I said, I am not sure if that is a good thing or not.  I am sure there are times when that got me into trouble with some people. I tend to take a direct approach and do not think ahead of time how to say things in the best way possible.

That being said, I think that there are a ton of people out there that worry a bit too much about things that have not happened.  I talk to doctors and team members alike that have had the best intention to have a discussion they need/should have but have not for this reason. They are concerned about one thing or another and that stops them from having the conversation all together, which honestly is worse than having a bad conversation in my opinion.

Therefore, I have some suggestions that might help those of you in the latter scenario:

First, try to stop worrying and just have the conversation.  Many times the longer you wait the worse it gets for you and causes you more stress than the actual conversation itself.  You don’t want to go into any conversation without a level head. If you are in the right mindset it is better to just handle it as soon as you can, rather than let it build inside of you.

Next, go into it with the right attitude.  To many times we go into conversations with people either looking to “win” or come to a final solution.   Those communications are confrontations, challenges, disagreements or fights.  The attitude that you need to easily go in without worry is to have a conversation.

The actual definition of conversation is; a talk, especially an informal one, between two or more people, in which news and ideas are exchanged.

When you go in with the attitude of an informal two-way communication where ideas are exchanged, it lowers the stress level associated with it.  Go into it with the plan to have the back and forth communication, not looking for a particular outcome except to get the conversation started and to learn more about their idea or thoughts.

Your goal regarding this discussion should be to learn more about them and their ideas, or whatever the topic is about, and to share yours with them.  Most hard conversations are usually just a gap between two people’s opinions, thoughts, memory of a situation or idea. You need to go in with the goal or outcome of better understanding, not necessarily agreement.  When you recognize that is your goal, you can more easily be open to asking how they feel about something and telling them your thoughts, without feeling the need to come to a conclusion or an agreement.

Finally, it is important that some conversations need to take place over time.  When you put pressure on yourself that you need a resolution the very first time you talk about a subject, it makes that discussion much harder. You can put less pressure on yourself by explaining to the other person that you are just starting the discussion to understand where they are coming from and to share your perspective.  It may take a few more attempts to complete your conversation, but at least you have begun the process.

Ensure that you have plenty of time for the conversation. And talk as long as it is productive. Pause the conversation if things get confrontational, or are no longer productive.  Go separate ways to let it all sink in.  Allow enough time that you are able to explain what you want to talk about and to be able to have a two-way conversation that can be revisited in the future. Afford the other person to have the time to know what you want to talk to them about but also to be able have a two way communication and then revisit in future conversations.  This will allow both of you to be thoughtful to not say something either of you will regret later.  It will also help build trust between the two of you to know that even tough conversations can be had without the need to worry.

Question: How can I explain to patients to pay for their limited exam out of pocket so they don’t use up the periodic exam? I would like some tips on how to approach patients when it comes to paying out of pocket.

Answer: It is important to know and understand your patients insurance benefits to educate, support and give accurate treatment plan estimates. The information that you receive when getting a breakdown of benefits should not be used to dictate a course of treatment for a patient. Regardless of insurance frequency and limitations, your ultimate goal is to provide the best service for your patients dental needs. As a provider of service you must always make the insurance company aware of any services performed for a patient. All services must be submitted to the insurance company and then the insurance company evaluates the services performed and pays the claim accordingly. Clearly communicate with patients about what amount of the payment they are responsible for if the insurance does not cover the estimated amount. The information received when getting a breakdown of insurance benefits can certainly assist and help your team when explaining patient balances. If your patient has further questions regarding their particular insurance policy always direct them back to their insurance company and employer for further explanations. Being insurance savvy is a huge value to your patients but looking out for the best interest of the patient and their dental needs comes first.

1. Check a patient’s eligibility– Get a full breakdown of benefits for all new patients or anytime patients change insurance. Be sure to also check electronically for all recare patients to make sure they still have active insurance. Ask patients about coverage changes at recare visits or any time there might be a concern. Know what questions to ask when calling insurance, and make sure the software gets updated correctly. Ask about things like waiting periods, missing tooth clauses, downgrades, etc.

2. Get a Payment Policy/ Treatment Plan Signed by Patient– Clearly communicate with patients about what amount of the payment they are responsible for if the insurance does not cover the estimated amount.

3. Submit the Claim with Correct Service Codes and Providers– Make sure what was completed was coded correctly and with the right provider before you submit the claim. Mistakes in this information can delay payment. Bill what procedures you actually do, regardless of what the insurance company says. It is insurance fraud to bill for anything except the actual procedure. Send the narrative and necessary radiographs to have the highest probability of getting paid in a timely manner.

Remember: You may have to deal with insurance, but you do not work for them.

You are here for your doctors and your patients. Understand that patients will not be happy when the insurance does not pay what is expected. It is ok to empathize with them. Let them know you understand that it isn’t ideal but ultimately, if they have a problem with their insurance, they need to discuss that problem with their employer. Your goal is to help them maximize their insurance if you can, but at the end of the day, you are there to help them keep their teeth for life. You are their healthcare provider.

Patients First, Insurance Second!

QUESTION: Do you have some scripting to use when rescheduling patients? We have discontinued any non emergent or urgent treatment for the next 3 weeks. My office administrator is fairly new and seems to have a little bit of a difficult time explaining this to them…I was going to put a script together for her but if you have something that would be great.

ANSWER: We are in a weird time where we are having to cancel a weeks worth of scheduled patients or they are cancelling on us, depending on the status of your office.  I suggest that you still follow the foundation of what we teach at Front Office Rocks but understanding that this is not a normal scenario, so some tweaking might be needed.

1) We don’t think you should have your team members read from a script.  That is cold and does not sound like it is coming from the heart, however, they do need some guidance as to what to say to your patients.  I suggest that you decide for your office what you are going to tell your patients and then have each person practice the words or a variation of them so they are comfortable with what they are saying and then let them use their words to explain to the patients of what is going on.

2) You should always try to never let patients leave without their next appointment and this is the same right now. As patient’s appointments are being cancelled, you should attempt to get them to reschedule while you have them on the phone.  The biggest concern with this is that most offices do not know when they are going to open again so my suggestion is to schedule them out a month or so, to be safe and let them know they will be the first patients you will call when you know for sure of when you are opening back up and they can move up if they want.  It is easier to move patients up in the schedule than it is to try to reactivate them later when they totally fall out of the schedule.

3) Keep a list or a way to identify all the patients that were scheduled during this time the office is closed so that you can move, reschedule or whatever is needed to get life back to normal with them when this shut down is over.  It is our responsibility to get in touch with the patients to remind them once we are back up and running that they need to get back in.

4) Lastly, plan a big reactivation campaign for now and when you get back.  Right now your team members could be reaching out to all the patients that have not been in for over 9 or more months and attempt to get them to schedule.  They might not want to come in soon but getting them in the schedule months from now is better than not having them scheduled at all.  Make sure your team is updating all the contact information for the patients so that when it is time to confirm their appointments, you have all the right information.  Also know that you will have patients just fall out of the schedule all together during this shutdown and when life gets back to normal, their needs to be a campaign in the practice to get those patients back in the schedule too as soon as possible.

The good news is hopefully all of the patients will understand and nice about having to reschedule their appointment.  They will understand so just help your team members be confident in this is the best decision for everyone’s safety and health.

I hope this helps.

Yes, you can still use Craigslist to post your job announcement; however, it shouldn’t be the only place you look for new employees when hiring. You are going to want to spread the word to as many places as possible to increase your chances of finding the best fit.

Here’s a few things to remember:

1. All the good hygienists are probably working somewhere else already, so you need to have a culture or a reason for someone to leave their current job to come to your office. Sell your office and company culture in your post.

2. Tell all your dental reps that you are hiring, as they are the ones that go in and out of offices all day long and know who is happy in their job or who might be looking to leave.

3. Your current dental team should be sharing on social media and spreading the word that their office is hiring because the dental community is small. Typically dental folks know other dental folks and that will get out to the right people. Maybe even offer a hiring bonus if a current employee refers someone.

4. Lastly, many offices are trying to hire full-time which limits the candidate pool. If that is the case here, also look at part-time too so that you can at least get someone for one or two days a week and then it can hopefully grow to full-time employment down the road. One or two days a week will help somewhat and many hygienists only work 4 days a week and are looking for another office for the 5th day.

I hope that this helps you find the best hygienist for your team!

QUESTION: What type of schedule have you seen work where the doctor incorporates assisted hygiene into their schedule? The reason they want to do this is because they are having trouble finding a good hygienist willing to see eight patients a day. They are in San Francisco and have a super competitive market for new employees.

ANSWER: What assisted hygiene means is the hygienist works with a dental assistant so they can see more patients per day. In this type of schedule the assistant is doing part of the duties during the appointment. Hygienists are the only ones that can actually do “hygiene or perio procedures” on the patients, but the assistant can seat the patient, review medical history, take X-rays, and in some states polish the patient’s teeth. Let’s say the normal appointment is 60 minutes long with assisted hygiene, the hygienist is only in for 30 minutes and the assistant handles the other 30 minutes. Now the hygienist can see more patients in a day and only do the tasks legally required to be performed by a hygienist. This type of schedule can definitely work and many offices do it very successfully.

Before switching to this type of schedule consider your team/employees first.

1) Do the hygienists want to do this? Not all hygienists like this schedule because it does not allow them time to talk with the patients, they literally go from one patient to the next.

2) How good are the assistants? Offices only see their patients some times two times a year and this way might seem like more of a “get them in and get them out” patient care mentality. It is important that the assistant takes the time to provide that great bedside manner, reminding the patients how awesome the office is and making sure they feel like they are important and not just a number.

QUESTION: You give great advice to general dentist offices, but I am in a pediatric dental office and have a marketing question. I watched the videos on referrals and offering teeth whitening as a good incentive for referring patients. What do you suggest we offer to parents/kids for referring friends to our office? We don’t have teeth whitening and 99% of our patients are insurance patients. I would like to offer a great incentive! How do you feel about movie tickets? I want to make sure it is enough to make them ACT.

Would you recommend gift cards, movie tickets or something along those lines? Or would you try to keep it more geared towards pediatrics? Spin brushes, water piks, fluoride tx or something like that?

ANSWER: I will start by saying that since I have never worked in a pediatric office, I am not going to claim that I am an expert in this area, however, I do have some thoughts. What I am about to say on this subject pertains to all offices that are running some sort of a patient incentive program. I suggest that whenever you have a contest or giveaway for patients that you have prizes that are fun and not dental.

I have two reasons for this approach:

1) I think it is more exciting for the patient to win or receive something fun, like a Starbucks gift card or movie tickets. As much as we think spin brushes and dental supplies are fun, the average person does not.

The reason whitening works is that is a cosmetic service that people do tend to get excited about. I also do not recommend that you offer incentives like a dollar or percentage off their dental work as it feels really lame. “Yippee, I got $x amount off my fillings.”

2) I want the patients to talk a lot to their family and friends about what they got from our office. You have a much higher chance of the patient being excited about two tickets to the movies and they tell their friend they got the tickets as a reward from their dentist.

Remember to check your state laws regarding giving patients gifts. Some states will not allow you to give a gift as a direct thank you for a referral, because it appears as though you are paying or bribing for the referral. However, you can run contests and send thank you cards to your patients anytime you want, as long as it is not contingent on their referral.

QUESTION: If I have two front office team members how should I divide the duties (receptionist/scheduler) and (treatment/insurance/financial coordinator)?

ANSWER: How you divide those tasks can really be done in a couple of ways. Begin by identifying where each team member shines. What are they great at and what do they like to do? Where do you see the most success from each employee? When a team member likes what they are doing, like answering the phones or ensuring the schedule is full and they are good at it, then assign that responsibility to them. Remember, others can help out in this area but one person is ultimately in charge to make sure it is getting done and done well.

The upside to dividing the tasks this way is you have someone who really likes and is good at something in charge of those tasks. You are setting that person up for success!

The downside is it may be a bit confusing if what they are responsible for doesn’t flow well in the patient flow or there are tasks that no one likes to do and those are entirely forgotten. For example, someone might really enjoy answering phones and presenting treatment plans, but it is difficult for one person to do both – if you want both done well.

There is another issue when someone does not like to do a particular task like reactivation calls, but their job is to fill the hygiene schedule. In this case, reactivation calls are part of that job and if they are responsible for the schedule, they have to also be responsible for the role of trying to reactivate patients.

This actually sparked a blog that we’re going to post tomorrow – so stay tuned and check back with us for the rest of the answer!

QUESTION: How do you deal with patients who are requesting a specific hygienist. We just had a patient cancel 5 min prior to their appointment because they were not seeing the hygienist they wanted to see. However, when a schedule falls apart we consolidate the hygiene schedule to one hygienist. Ideally, I want very few of these preferred hygienist patients but I don’t know how to control that.

ANSWER: For practices that have more than one provider seeing patients, ie… multiple hygienists or doctors, the best-case scenario for the office, is to be able to move the patients around as needed according to what works best for the schedule. However, there are some patients who only want to see a certain provider and of course, the office should honor that. Here are some suggestions on how to manage this issue.

1) Make sure the team is being very clear not to communicate to the patient that they will see a certain provider or offer the option to only see one provider. This is especially important from the clinical team, as they like to have the guarantee that a patient only wants to see them, however, it makes it very hard when that provider does not have availability or is not working. The communication should always entail that every clinician at the practice is amazing and the goal is to find the day and time that works best for the patient to get the treatment done.

2) However in some cases, a patient will request to only see a certain provider and in that case, the office should honor that or be very clear when that can’t happen. When a patient asks for a certain provider only, the team member should mark that in a place in the practice management software so it is obvious and then communicate to the patient that the office will do their best to honor that but in case it can’t happen, they will let the patient know in advance so they won’t be surprised to see a different provider or to reschedule with plenty of notice. Then if there is any change in the schedule with the clinicians, those patients that request only to see that provider should be notified and handled accordingly. Many times when that happens if handled correctly by the team member the patient ends up being more concerned with keeping the original time that fits into their schedule that they end up seeing the different provider in the long run. Then when that appointment is done, if the patient is ok with the change, ask them if both providers could be considered in the future to care for them. However, there are some patients, typically super fearful patients that will definitely want to move their appointment to when their preferred clinician is available and the office should honor that request.

3) The biggest issue is that the office as a whole needs to have a “no big deal” feeling toward the patient about seeing different providers. If the office focuses too much on that issue, the patients will focus on wanting a specific provider which makes it hard on changes in the schedule. There will be certain circumstances where the patient is going to have an issue and putting customer service first, the office should never surprise the patient when they arrive with the news that they are seeing someone new or that they have not met before. To learn more about providing your dental patients with the best patient experience possible, visit the following doctor training webinar course module!

QUESTION: Can one organized person at the front desk run things smoothly enough in a small office with one doctor and one hygienist? We also have one assistant, a part-time person who pulls charts, confirms appointments, and helps file, and a part-time person who assists with billing. I feel like this is too many employees for the volume of business the office handles, and we really simply need a very organized front desk person to run things and manage the office well.

ANSWER: It is very doable for an office with one doctor and one hygienist to be run by one well-organized person. The volume of what happens in a two-clinician office is not too high for one person to handle. However, that being said, there are some issues to consider. First, everything seems to happen at once at the front desk of a dental office. Therefore, when there is only one person in the position, it can be difficult to check in patients because this often occurs around the same time that patients are checking out. This also is not taking into account answering phone calls. It is vital for the phones to be answered, and that can be hard for one person when checking patients in and out. Another thing to consider is who will handle consultations when they come up.

So, yes, one person can handle all of this, if the person has a great support system and good systems in place. There needs to be another person, such as the dental assistant, cross-trained to jump in as needed, to check patients in or out or help answer the phones. There needs to be a back-up plan if the one person at the front desk steps away or is extra busy. The others on the team can check in out or walk out patients. Training is key for making sure all of this is successful.

The other issue to consider is the ability to grow the practice. One person may be able to handle the current workload, but if the practice is trying to grow, then there needs to be enough time for this person to make calls to get unscheduled treatment scheduled, reactivate patients, and more. Also, if the practice is actively growing, then this person will eventually need help and it is better to consider that now when there is time to find the right person, train the person the correct way, and have the person established enough to pick up the extra workload when needed.

Visit the first publication of this article via DentistryIQ, here.

QUESTION: Should I sign up for credit card processing for my office?

ANSWER: Think outside of the dental box for a minute and think about the rest of the world, there are not many places that you can go to where you cannot pay credit card. Everyone expects to be able to pay via credit card no matter where they go, and the dental office should be no different.

Especially because a dental office has larger ticket items and many times, people don’t always have that amount available in cash or their bank accounts, leaving them less like to accept treatment and more willing to push back when it is time to pay, if the office does not accept credit cards.

To learn more about payment processing and patient accounts at your dental practice, take a moment to review the following course module!

QUESTION: I really don’t have time for training my employees. We’ve tried in the past, but it always falls to the wayside. I’ve asked my team to take initiative and asked them to help each other. Isn’t it just easier to have my team show the new employees the ropes or how they do it? Or have the current employees train their replacements?

ANSWER: You can use training to learn a skill or you can use training as a consistent positive reinforcement tool.

In a dental office, there is huge value in regular and consistent training. We all deserve to take a step back from production to work on ourselves! Now, let’s talk about whether your employees should train each other and their replacements. Are you at your maximum production? Is your schedule packed with high value appointments with less than 5% cancellations and no-shows? It’s in our nature to pick up shortcuts and bad habits along the way, there’s no getting around it. That’s why we encourage experienced employees to take some refresher courses along with new employees.

Your current employees have experience with their role and your office, but are they performing their duties in the best way possible? You also mentioned that you don’t have time for training, how are your employees going to train each other if they don’t have the time? This opens the door to more shortcuts, or missing vital pieces of the job.

Let’s go back to the concept of “no-time.” In a dental office, the one thing we are always lacking is time – we totally get it! There are ways you can help your team with this and it all comes down to how this training is implemented. It doesn’t happen if you don’t prioritize it and schedule it. You can’t tell your team “to train” and then not make time for it. Want to know how we made time for training in our dental practice?

Watch the youtube video here.

QUESTION: We are trying to implement a bonus system for our assistants after reading Laura’s article. Right now, we have two goals one regarding night guards and the other for whitening. We are receiving push back from both assistants because they feel the goals aren’t fair – the numbers are too high and the one with the night guard goal feels it’s harder to achieve than the whitening goal and that she’s at a disadvantage. What is the best way to implement this with the assistants?

ANSWER: I have two thoughts on this situation. It’s fine if the office keeps the goals around night guards and whitening because the focus is on what the doctor wants to achieve. I would first start by looking at what they’ve done in these areas in the past. If they’ve only sold two whitening‘s in the last 30 days and the doctor set a goal to do 20 – that’s not realistic. It is important to know the set goals and how those relate to their past numbers for those procedures or items.

You cannot expect huge numbers overnight so setting a system with realistic expectations but that stretch the dental assistants to work harder is completely fair. Next, have a conversation with the dental assistants to find out what they think is fair. If it doesn’t motivate them then they’re not going to attempt to achieve the goal. The issue here is to determine whether the goal is really not set fairly or are the dental assistants just not motivated to work harder.

We had a question asking about if we need to hire somebody with dental experience or not when hiring for the dental office. This is one of my favorite topics and it is also a reason I founded and started Front Office Rocks.

Watch Laura’s YouTube video message here to find more of her thoughts on the topic or continue reading on below!

My background, just to tell you a little bit about it is, I was married to a dentist for twenty-two years, I was married to him through dental school and we opened two practices together. I’ve been in dentistry and around dentistry for a very long time.

When I started in dentistry in 2002, I didn’t know anything about teeth. I didn’t know teeth had numbers, I didn’t know procedure codes. I didn’t know surfaces, I didn’t know Dentrix, Eaglesoft, I didn’t know anything. I knew human resources, management, sales, and marketing. I was in the corporate world when he went to dental school. He then decided to open a practice and said, “Hey, come work for me! It’ll be amazing.” So that’s how I got into dentistry. I didn’t know anything about the dental part of things but what I knew was sales and marketing and management and I bring that value to the practice. I had to learn all the other things but you can learn these things right, which is really why I started Front Office Rocks. I would have people telling me all the time, there’s no place to teach them, there’s nobody to teach things like dental codes and procedures and scheduling and Confirmation calls and all of that. So that’s why we have Front Office Rocks is to solve that problem.

So let me talk about my reasons why I think that you do not have to hire based on dental experience.

I think there are multiple reasons. Now, I’m not saying there’s not amazing Rockstar dental professionals out there, if you found somebody with experience that is amazing! I’ve trained tons of people who now work in multiple offices and they’re Rockstars, but many times it’s hard to find somebody with dental experience and when you find somebody with dental experience a lot of times.

They cost you a lot more than somebody who doesn’t have experience. Which, if you’re on a tight budget or you’re worried about overhead, maybe it’s okay to find somebody who doesn’t have dental experience and train them up the way you want versus having to pay more for somebody who knows what they’re doing walking in. I have to be careful of that because I love my Rockstar front office trained people but I want to make sure that you know you don’t have to hire somebody with dental experience. One of the other reasons that I shy away from hiring people from other dental offices in the past is that many times when you hire somebody who’s been in another dental office, now to come in to yours, they also bring whatever they’ve learned, how they were trained in that office – into your practice. So basically, whatever the other doctor wanted, whatever the other office team culture was like, whatever their policies were, when you hire somebody with good dental experience, they’re gonna bring that into your office. Now that could be a great thing because maybe they’re amazing and they have great policies and suggestions.

I have lots of friends who are office managers who’ve moved to other jobs and made amazing differences for those dentists, however sometimes it’s not good. Sometimes, they’ve got bad suggestions, ideas and policies and so you just have to be conscious and careful of that.

Here is why I think hiring somebody with not dental experience is a great idea.

When you hire somebody from another industry many times you can find somebody who has got great experience that you can apply in the office. I’ve hired people who have managed restaurants, insurance salespeople, I had somebody who I hired who used to sell solar for your houses, bank tellers, hostesses, these are people who have great skills, great things that can bring it to your practice and all we’ve got to do is teach in the dental, they already know how to multitask. They understand the importance of customer service, they potentially are great at sales, they have no problem talking about money. They’re not insurance driven, they’re not so focused on insurance, they’re focused on getting the patient the help they need.

If they come in with a fresh perspective and we can teach them the dental, I mean, I didn’t know about dental codes and procedures, they can learn that but they can bring a whole new fresh set of skills to your practice that maybe you’ve never had before. The other thing is to realize that when you’re looking at personality as king, is priority over Dentrix and Eaglesoft, I would rather hire somebody who’s a go-getter, a multitasker, create at customer service, super fun, has a lot of energy and I’ll teach them Dentrix and Eaglesoft. I don’t need somebody who has two or three years of Eaglesoft experience but doesn’t have the right personality.

For me, personality wins over a dental experience every day, specifically in the front office. I don’t think you need to have anybody in the front that has dental experience especially now with tools like Front Office Rocks because we can teach them that. You can put them in front of videos, they can learn what they need. If they’re a good person and they learn fast and they can multitask and grow and adapt and take this on you’ll have no problem training them. I’m going to add to that too, even for the back, I think many times I see you know ads for dental offices and you need as a hygienist, you need five years of experience or two years as a dental assistant and experience is good. Don’t get me wrong, but there are a lot of new graduate dental assistants or hygienists that are rockstars, compared to people who have ten, fifteen or twenty years of experience, who are very knowledgeable and experienced, but don’t have the right personality.

So, I would not decide who you need to hire based on experience alone. Really look at the candidates, do they have the right personality? Do they have the right work ethic, can they learn, can they grow? Are they a Rockstar? No matter how much experience they have and can you teach them what they need to know?

You’re gonna have much more success building an amazing team when you build the team on the right kind of people, not just on the amount of experience they have. I’m all about giving everybody an opportunity and experience in a dental office is something you look at when you’re when you’re looking at resumes but is not something I am not going to consider first and foremost. I look more at skills, personality and traits, before I worry about their years of experience.

QUESTION: I have a question regarding being the leader. You gave an example of washing the dishes if you see there are dishes in the sink. What if you are continually washing the dishes and no one takes the initiative to do the task and it’s a given that “oh you’ll do it. How do you handle that?

ANSWER: In one of my training videos here on Front Office Rocks I talk about being a leader in the organization and that you don’t have to have a title after your name to be a leader. You don’t have to be the office manager or the lead assistant or the doctor, that everybody should be a leader in their own way and part of being a leader is doing the right thing and leading by example.

Don’t just wait for somebody to tell you to do something. Don’t just do only what is written in your job description but actually find ways that you can help the team out, find ways to motivate each other, do things that are above and beyond what is written in your job description.

You can also watch Laura’s YouTube video message here to listen in on her reply and find more of her advice for handling these types of sticky situations at your dental practice, or continue reading more below!

That is really what a leader is. Leadership really comes down to integrity and integrity is doing the right thing whether somebody’s watching or not! In this example, I talk about the break room and lunchtime and I don’t know about your office but in my office a lot of times what would happen is people would finish lunch, they would throw their dishes in the sink and then the person who has left there at the end had a pile of dishes in the sink. They would throw the dish in the sink and leave and just cross their fingers nobody noticed or they got stuck doing all the dishes.

A good leader, a good person, somebody who I would want on my team is probably going to take the minute or two if they have time to clean the dishes and put them in the dishwasher but here’s the issue that came up and that question that I got from the client which is what if you’re always the person doing it? What if you are the one who’s always doing the dishes to the point now where the rest of the team goes, “Don’t worry, you know ‘Laura’ will do the dishes. She always does them!”.

That’s beyond leadership, that is beyond you being accountable for doing the right thing. That really now is part of a system, policy and procedure in your practice. We all need to follow the rules if we’re gonna work in a team environment, if we’re gonna work together we need to have rules, we need to have guidelines, we need to have policies about who does what and when.

In this example of the dishes and the sink, you need to decide in your practice what is the policy around it? Does everybody do their own dishes, do we all take turns, one person gets Monday, one person gets Tuesday and how are we going to handle this because it’s not the responsibility of one person to clean up after the rest of the team!

QUESTION: Should the front desk employees be responsible for marketing the dental practice?

ANSWER: This is a hard question to answer because marketing can mean many different things depending upon who you ask. Your Front Office Team plays a huge role in converting marketing leads into new patients and encouraging patients to leave reviews and provide referrals. Beyond these two areas, your Front Office employees can help post images online and respond to messages on social media, but if they’re not trained in marketing their abilities are limited. Would you ask your cleaning crew to prep your operatories? They could do it – but it may not be right. Most dental offices want more new patients, but they don’t know how to get them. For many offices, the big questions are, “What marketing works?” “How much should we spend on marketing?” and “How do we know which marketing to trust?”

Because the marketing process can be confusing, and because most offices do marketing as an afterthought due to the fact that they must address more urgent tasks (such as running a business and treating patients), one of three things will likely happen:

Read more here.

QUESTION: I bought a practice with existing staff….how can I change things or start implementing new things without rocking the boat or making the existing team feel threatened?

ANSWER: Change can make employees feel uncomfortable because it’s unknown and different. If they’ve always done it this way, you’re asking them to change a habit. When I ask why they do what they do, I hear the same answer from each and every employee: “Because that’s the way we have always done it.” The employees have no idea why they are doing these extra tasks or answering the phones the way they do. They just keep on doing it that way because it’s how they were originally trained, and they never stop to think, “Why do we do this? Is this necessary? Is there a more efficient way?”

I suggest taking a moment to review all the systems you have in place, and decide if they are necessary and producing the intended results. Analyze if there might be a better way or a more efficient way. If there is a daily or weekly task that falls into a questionable category, discuss it. Ask: “Why do we do this?” and “Are we getting the results we want from this?” If you or your coworkers answer with something like “I don’t know, this is just the way we have always done it,” then decide whether there is a better or more efficient way.

Many times things become rote in an organization, and everyone just becomes a creature of habit. But it does not have to stay that way. You have the benefit of an outside perspective and are looking at the office with fresh eyes. Change within organizations often brings with it the unknown, and the unknown can cause people to go into panic mode.

Take the time to identify what might need to be updated and discuss the changes with your team. Explain the “Why” behind the changes and get the employees buy-in. And Lastly, reassure your new employees that you’re looking to reduce the office stress and increase efficiency to benefit them.

QUESTION: How to respond to negativity the right way! We have an employee that is usually very easy going to work with but the second we give any constructive feedback, she becomes hostile and starts finger pointing at other employees and creating a negativity cycle for days until it blows over.

ANSWER: Unfortunately, morale will take the biggest hit, and that eventually affects the bottom line as well. When morale suffers because the bad employee is perpetuating a culture no one wants to work in, the office will experience increased turnover. You may also start to lose existing patients and fail to retain new patients if no one wants to be in contact with the bad employee. Instead of the bad employee working for the office, this employee is controlling the office with their undesirable behaviors or lack of motivation. In short, the ongoing employment of this individual brings emotional and financial costs for every day they continue to clock in. You need to nip this in the bud quickly and not allow this behavior to continue. a good employee must be able to accept constructive criticism from the dentist or practice owner and transform the feedback into a problem-solving approach to improve the situation.

Before making any sort of assumptions, take some time to reflect on who this person is, what it is about them that’s coming across as negative, and—this is where you’ve got to really dig in and be honest with yourself—what role you might be playing in their perceived misery.

Is it what they’re saying that’s negative, or how they’re saying it? The former could be someone who’s truly negative, but the latter could just be a miscommunication issue or communication style divide. Check your biases to see if you’re judging this person based on how they deliver their feedback in a way that’s different than you do—rather than the feedback itself.

Now, the tough part: sitting the person down to talk through their behavior and give feedback. The first step in this conversation is to set the boundaries for how you’d like your team to work together—not to jump on them. Then it’s up to you to make an explicit request of what you would like to see changed going forward, describe the situation, outline their actions and behavior, and explain how those actions affected yourself and others.

QUESTION: My staff is defensive whenever I suggest trying something new/something else and they’re very hesitant to change. It’s not personal, I just want to see if we can do it better.

ANSWER:There’s a correct way to implement change and it should be a positive experience. Sit down with your team and discuss why you’d like to make this change and what your plan is, then open the discussion up to getting the team’s feedback. Including the team’s perspective helps them to feel important and empowered at your dental practice.

If the entire team is informed about the initiative, trained appropriately, and understands why the change is positive, it should be easy to implement. When it’s not easy or is met with resistance, I suggest you take your focus off the change and shift onto who is pushing back. When a positive change is being resisted, an employee must be making an effort to stop it and avoid implementation.

When you discuss the idea with them they seem fully on board, but then you hear they were talking to other team members about what a bad idea it is and why it won’t work. You need to address this employee. There are a few reasons why employees are resistant to change and you can read more about those here.

ANSWER: Deciding on which, if any PPO plans your office should sign up with depends on many factors, such as your demographic, competition, age of your practice, the economy of where you are located and so much more. There is not one right answer to this question, as it varies from office to office. It is important, however that you get help when making this big decision which could haunt you for a very long time. Work with a company that can help you evaluate all these things and guide you to making the smartest decision.

QUESTION: Is it worth having an outside agency handle installment payment from patients even though I have to pay them?

ANSWER: Again, it is so much smarter to have an outside company handle the installment payments with the patient, rather than trying to do it in-office. The dental front office team is not trained in, nor do they want to be a collections department. The patients many times have issues with their payments, such as a change of credit card or low balances in their accounts and then the front office team is spending time and energy tracking the patients down to try to get it straightened out. Finally, if a person has to make decisions of which balances they are going to pay if they have to prioritize, they are going to put a finance company much higher than their dental office. You will be the last to get paid.

The best policy is honesty so telling the patient that you cannot adjust anything as it is insurance fraud is the best answer. There is no reason to make up an elaborate answer to this question. If the patient feels your confidence and your honesty, the patient might not be happy with the answer, but they probably won’t ask and will respect your office.

QUESTION: We want to appeal to out of network patients too, so how do you answer, “do you take my insurance”?

ANSWER: This question has to be answered with yes or something positive. A patient only knows typically to ask two types of questions when they call into a dental office, something having to do with their pocket book or their insurance book. If the office starts their answer with no, then the patient just wants to hang up. Therefore, the employee should find a way to answer their question with something positive, like we work with a lot of insurances or yes, we take PPOs and then take control of the phone call. Find out more about the person on the other end of the phone and build rapport with them. Then you can handle the insurance question in more detail once you have gotten to know them.

The first thing that I was taught getting into the dental industry early on was to always remember that we are a dental office and not a bank. You should not accept installment payments from patients in office and only work with a third-party finance company if the patient does not want to or cannot pay in full. There is so much risk in doing dentistry on a patient that has not paid in full and plans to make installment payments. Also, there is a lot of administrative time wasted by managing the installment agreement and most of the time, having to track the patient down to get the agreed upon payment.

The office needs to be in control of their schedule and not fill it with flakey patients, so the best way to handle no shows is to get the patient’s commitment of the importance to show up, their agreement that they won’t not show up again without notice and charge a deposit to reschedule if it makes sense.If the patient no shows again, then the office needs to decide how many times someone is allowed to do that until they can no longer pre-book appointments in their office or maybe continue to come to the office. The dental office can decide who can schedule with them and if they continue to not show up, then stop appointing them.

Patient refunds are either done because the patient over paid for treatment or the treatment did not get done or get done to satisfaction of the patient. Either way, it is important that the money is refunded to the patient in a timely manner so the patient does not get upset or upset even more if there is a delay. If possible, cutting the patient a check is the best way to do it, because if you run the refund on the credit card, your office will have to pay the credit card charges to process it. If the patients paid initially on credit card, then that means your office paid twice.

There are three types of cancellations: new patient, hygiene and doctor production, each with their own issues. To minimize new patient cancellation, slow down, build rapport with the new patient, handle all their questions, and get them scheduled to come in within 48-72 hours.

To decrease production patient cancellations, ensure the patient is fully on board to do the treatment by getting a deposit for their appointment. For hygiene patients, retrain them that it is not okay to cancel. This will be more effective with good verbal skills, do not make it too easy for them to cancel and get their agreement that they understand their commitment and will show up to the appointment.

A good vacation policy for the team is one that benefits the employees and does not take away from the business. Of course, there are laws that need to be followed and it is important that you consult with legal or HR advisor to make sure laws are being followed.

Beyond that, then the next thing to consider is things like did the employee give enough notice, did they follow office policy to request the time, will the time off not impact the running of the office, did someone else request off first? Remember that vacation is a benefit that are offered to keep employees motivated and around a long time, so if they follow all the policies, then make it easy for them and say yes.

It is time to hire someone new to your team, if you know for sure your team is doing them most that they can efficiently, and things are not getting done in a timely manner or patients are not getting in right away.

There are many different formulas out there that consultants recommend; however, the first step is to assess how efficient is your team, are they fully doing the most that they can do and if so, what is not getting done that should be. When you know that you have everyone running and full capacity, but it is not enough, then it is time to hire.

There are three things that I suggest when working to help patients accept the treatment plans, Clear, Confident and Caring. First, don’t present too many options to the patients because a confused mind won’t buy. Present to the patient the best option and let them know why you are treatment planning that for them.

Next be confident in your presentation because if the patient hears any hesitation in your voice or the way you present, they are less likely to believe or trust you. Lastly, make sure you care about them and they know it. Dentistry is not something most people love and if they feel you are just after their money or trying to fill the schedule with production, they won’t accept. People don’t care what you do until they know that you care.

QUESTION:

Can you do a video about employees having their cell phones out at the front desk and patients or other employees seeing it out and on it? I think employees hearing from you makes such a difference, maybe giving them a different perspective other than it’s just an office policy? Thanks!

ANSWER:

QUESTION:

It was noted that you recommend 20-30 minutes for a morning huddle. Is this 20-30 minutes considered paid time where the employees clock in? And if so, considering that a practice would have an 8 hour day after the morning huddle, would everyone be receiving 20-30 minutes of overtime pay due to the morning huddles?

ANSWER:  Yes, the employees need to be paid for the huddle. Anytime the employees are required to do anything, such as be there for the morning huddle, they have to be paid.

I am not an HR specialist and each state is different, so I suggest you check with someone who knows your state laws but normally, over 8 hours a day is overtime. You have a couple options.

You could do different start and end times so that some of your team is in the huddle but they leave 15 min early at the end of the day and the second group comes in later and leaves later. It is important than that those that are in the huddle, transfer the information to those that come later. Or you could end the day a bit earlier or you can just pay 15 min of overtime. Again, this really is more of an HR/legal question but those are my opinions of options of how you can handle this.

The purpose behind your morning huddle is to get your entire team on the same page with your current days schedule and head off any questions or concerns that may come up through out the day. This will help to keep the flow of the office running smoothly with the least amount of bumps in the day. Most offices find this as a valuable time of the day and strive to keep the huddle informative and motivating. Huddles can vary from office to office but range anywhere from 15-30 minutes. You can use huddle to review previous day activity, current day and the next day to help with maintaining office goals and consistency. Take a look at our sample of a Morning Huddle Agenda so you can see the valuable information reviewed during that meeting.

QUESTION:

We recently hired a new non-dental front desk employee who we LOVE and are excited about. She was hired to replace an employee who said she was going to be leaving – did not put in notice – then decided to stay. This employee is here for the paycheck and the doctor is concerned about paying unemployment and patients leaving (small town).

ANSWER:  Here are my suggestions to help in this situation:

1. Make sure to speak with your HR department or service provider regarding the ins and outs of unemployment before taking any further actions. If there is a solid file with write ups, warnings and consequences, there may be a chance to win any claims and not have to pay a thing. If the situation is well managed, documented and handled with the help and advice of your HR team, there may be an opportunity to use performance management to help clear up the situation.
2. I have also attached the link to an article that I wrote for The Profitable Dentist on this very subject for you to review. It’s hard to let people go, but in the big picture the practice is the priority and finding the right attitude and personality far outweighs the awkward conversation.
3. I think it is also important to speak with your new employee and let her know that she’s doing a great job and she is valued.
4. We also have a relationship with John Stamper who has a program called RightFit that I feel would be of great help to you. They may be able to help move the team around for you, manage any dismissals and can help you build a team that works well together and essential, will help to grow the practice. Tell them Front Office Rocks sent you!

I hope these suggestions help and thank you for reaching out.

QUESTION:

We have a patient who had his wisdom teeth extracted, back in June of 2016. At the time, the office was out of network with his insurance. He had primary and secondary coverage, both were out of network. Since starting with the practice in May 2018, I’ve been doing a lot to collect on patient balances. The prior front desk did not follow through with most claims or communicate patient balances with the patients. This patient has a significant balance and I need to collect or send the patient to collections. When speaking with the patient’s mother, she feels that our office messed up and we need to eat the balance. I have tried to do my best and help this patient, I have contacted the insurance companies to check on the claims and because the office was out of network, they will not release the EOB’s. The primary insurance company did tell me that the patient was sent a check in the amount of $850.00. The patient did not notify the office that a payment was made and cashed by them. Since the office was out of network, we did not have a copy of the primary EOB to submit to their secondary. The patient also had made a payment arrangement with the office. The patient is refusing to pay the balance and says that if we send her to collections then she is going to write bad reviews on social media and our google site. Any advice you can give is appreciated.

ANSWER:  Wow – that is a tough one! I am sorry to hear that you are dealing with this issue. Here are a few of my thoughts.

Ultimately, the patient owes the money. I understand that but you have to determine how important is it to collect that balance (or should I say, your dentist needs to decide). I am not saying that you should write it off because she threatened to write a bad review, however, in a way, it has been sitting there since 2016. At this point, it seems like a lost cause and if it were my office, depending on the size of the balance, I would probably write it off. That being said, you have to see what the doctor wants to do. I think that your office is correct in that she owes and that you could send the patient to collections, but you have to weigh out the chance of them paying it and the cost associated with going after the money. I also think that your office dropped the ball with letting it sit there for so long, which I know is not because of you, but your doctor might want to factor that in when deciding what to do.

Another option might be to have the doctor call the patient to discuss options with her. If your doctor really feels the balance should be collected, the call from the doctor may be more successful in moving the patient in the right direction.

One final option might be to split the balance with the patient. Whenever I had a patient that I felt owed the balance but I could see that we needed to potentially take some of the responsibility, I would explain that to the patient and tell them that I think it is fair that we write off half and they pay half. At least you get paid some of the outstanding balance that way.

If you and your doctor really feel that it is important to send her to collections if she does not pay, then I understand that too and don’t hold back from doing it because they threatened a bad review. Just be prepared for it by having a response ready and patients ready that you can ask to put out good reviews to bury it if she posts it.

Then finally, make sure that you learn from this past issue so this does not happen again. When cleaning up old balances, you can find great examples of where the office dropped the ball and then write policies to ensure that it hopefully does not happen again in the future.

First and foremost, we need to help our patients understand that radiographs are a necessary part of providing the patient with the best care and most informed diagnosis and treatment plan possible. If we don’t have the necessary radiographs, we compromise care for the patient by not providing competent care.

The ADA publishes recommendations for patient selection and limiting radiation exposure and you can find those criteria on their website.

Too often we allow insurance to dictate treatment, including when we take radiographs. We need to use the guidelines suggested and good judgement with each patient individually to determine the best course of action. In turn, just because a patient’s insurance will cover it, that’s not reason to take the radiographs either. We should use common sense and let the patient’s history and needs determine what is best practice for that patient.

The usual reasons patients have for not wanting radiographs are Fear, Pain and Cost. We all have those few patients who have an issue with anything we do but we need to be ready to address our patients concerns as they arise.

Fear (usually of exposure) –
“Patient X, dental radiographs today are the safest they have ever been. The amount of radiation exposure is extremely limited due to the digital technology we now use. Because we can only see a portion of the tooth visibly, these radiographs provide us with valuable information about the part of the tooth we can’t see under your gums, around your fillings, crowns or other dental work, and in between the teeth.”

Pain (or gag reflex) –
“Patient X, we completely understand your concerns and today we have options for x-rays that are easier, smaller and more flexible to help with pressure points and gag issues. We will take it slow and help you through the process.” If necessary, a panoramic radiograph is always better than nothing for a patient who just can’t do otherwise.

Cost –
Sometimes patients use this excuse when there are other factors such as fear but there are options and if you feel the patient truly needs the radiographs there are ways to work with the patient who truly can’t afford them. Offer to have the patient pay at the next appointment, offer to take the radiographs at the next appointment so they are prepared to pay or comp the cost as a one time courtesy but let the patient know this is so you can give them the best diagnosis and not usual and customary.

If a patient refuses to have the needed radiographs, the patient may be dismissed from the practice. From a legal perspective, even if the patient signs something saying they refuse the radiographs, they can’t give consent for the practice and/or dentist to be negligent. If a patient refuses radiographs for proper diagnosis and they later develop a “dental issue”, the doctor could become involved in a legal battle.

Patients can choose to not have radiographs but the practice/doctor also has the right to dismiss the patient if they feel they cannot provide the best care for their patients due to incomplete diagnosis with out the proper radiographs. Good communication with the patient and good documentation in the patients’ chart is key.

It is crucial that the entire team be involved in understanding the best practices for our patients and that the same message if being sent to the patient. “We understand your concerns about radiographs but we are not able to provide you the best care you are accustom to without diagnostic radiographs. We would ask that at your next visit you would be prepared to have these radiographs taken so we can properly diagnose and treat any necessary findings.” If the patient continues to refuse the radiographs, then decision to dismiss the patient from the practice may need to be considered.

If the doctor decides a patient should be dismissed for refusing radiographs, some experts recommend that a dismissal letter be sent to the patient and that the terms “failure to treat could result in permanent, irreversible damage to your dental health” be included in the letter.

When our patients have the knowledge provided by us to understand the importance of radiographs and the benefits to them for best care, typically there is less issue with refusal. We need to look at each patients needs and not just a usual standard that radiographs are taken every year or at their recare visits. We always need to keep the best care in the forefront for our patients and the key is communication and documentation.

QUESTION: We opened 13 years ago and were initially in network for all PPO insurances and we have now decided to get out of network with insurance. I know you have mentioned in your videos that your offices are out of network with most insurance companies. Are you also out of network with Delta Dental? In Wisconsin, if you are out of network with them, they mail the check directly to the patient. Do you deal with this and if so, how? I am fearful of how to handle this transition. Can you offer any advice but specifically on how to handle checks getting mailed to patients? I appreciate all the advice you can offer as we transition to a fee for service office.

ANSWER:  Here are a few of my suggestions:

1. ) Get involved with the Facebook Group, Fee For Service Dentistry, started by Dr. Drew Byrnes and look up his Fee For Service Podcast. Both of these will be great resources as you move forward down this path.

2. ) The next thing is to train your team on this change and how to explain the change to the patient. You want to give your team the confidence by being confident yourself with these points. If the team presents this as if it is not a big deal and that there is nothing to be concerned about, then the patient will be more likely to be okay with the updated change.

Here are a few key points:

• It is not your decision to have the checks go to the patient, it is the way that Delta does it and there is nothing you can do to change it. Make sure the patient understands that with most other insurances, the checks can still go to you but since they have Delta, it has to go to them. You want it to be clear that the reason is because of Delta and not your office.
• You want to spin in confidently by giving the patient the positives of this. Ultimately, the patient is the client of the insurance company, not the dental office and because of that, the insurance company wants to keep the clients happy whenever possible. Therefore, many times when they see that the check is going to the patient and not the dental office, they may approve more without pushing back as much and they pay faster.
• Your office will still submit all that is needed to get the claims paid, just as you always have done and will follow up with the insurance if there are any delays or they need more to process the insurance claims. This all must be done to make sure the patient gets paid.) Role Play this with your team until they each can have this conversation comfortably and confidently with patients. You don’t want them quoting a script but instead, make sure they can comfortably explain in their own words.

3. ) Role Play this with your team until they each can have this conversation comfortably and confidently with patients. You don’t want them quoting a script but instead, make sure they can comfortably explain in their own words.

QUESTION: Hi Laura, I am new to office administration and trying to figure out how to maximize our hygiene schedule to meet our goals. Is there a way to assign colors per dollar value with high, medium, low, possibly to aid in scheduling? How do you recommend making sure the hygiene goal is met per day? Hygienists do most of the scheduling in their rooms. They are putting in treatment for next visit before they leave now so we know what the value of that appointment will be. I would appreciate any input you could help me with.

ANSWER: Thank you for reaching out to me about this, I am glad to hear that you are thinking in terms of production with your schedule, which is better than most offices. I have to be honest though, I don’t necessarily think that is something I would recommend for hygiene. The reason that I don’t think that it is necessary for hygiene is that their dollar value amount really does not have too big of a range. The difference between a prophy and a perio appointment is really only a few hundred dollars, versus a low to high dollar appointment for the doctor. Putting a prophy with exam and fmx won’t make or break the office production versus just a prophy and exam. Therefore, I don’t suggest worrying too much about production for hygiene.

I would say however, that hygiene has two other factors that are more important for me, which is variety of appointments per day per hygienist and no downtime.

1. Variety: Due to the nature of the procedures that hygienists perform – having a good mix of them will not only help the hygienist reach their daily goal but it will also help to prevent burn out. If the hygienists are doing the same thing over and over, especially a low production appointment, they will not hit their goal and/or will get tired of repetition. I think that it is more important to have a mixture of high and low dollar value appointments for them each day.
2. Downtime: Where the doctor’s schedule should be built based off production, a hygiene schedule needs to be productive too but you will have a much better chance of it if you make sure they are busy the entire day. You want to make sure that there is no downtime in between appointments in hygiene in order to make sure they hit their daily goal.

QUESTION: I am new to the front office and have a question about verifying dental insurance. I am brand new to the front office and I have a question about verifying dental insurance. Can you explain exactly how I go about doing that and what information I should be looking for?

QUESTION: I am opening a start up oral surgery office. I am working on building a new referral base. Do you have any tips?

ANSWER: Thank you for your question and congrats on the new office. I have not written much on this topic in the past but here are some thoughts that may help.

1. Referring Doctors – the first dentists to contact are the ones that you want referring to you. My suggestion is that you arrange meetings or a lunch with them and start to build some rapport. I also suggest that you find out possibly who they refer to now and why they like or don’t like them. I would find out if they have issues with any of their existing referrals and what you can do to be given a chance with some of their referrals. Aim to find out clearly from them what they are looking for from you, what they are NOT getting from their current oral surgeon and how you can do it better. Talking with the doctors is the first step to getting your referral slips, or cards, into the office.
2. Referring Doctor’s Team – Once you have won over the doctor, the next step is to win over that office’s team. I would suggest finding ways to get in front of the team, if possible. Host a CE event that they will find value in, offer a ‘Lunch & Learn’ for the team, or host a team appreciation event. Many times the dentist is the one that decides that the patient needs to be referred and unless they specifically say to whom, the team will refer the patient to the office that they prefer the most, or is the easiest to work with. Make sure that it is your team they are referring.
3. General Public – If you want patients to call your office too, without a referral, then market to the public. I am not positive if this works for oral surgeons or not, so you might want to ask other specialists or social media groups, to see if others have had success. I would also suggest, possibly hosting some events for the public, such as, an open house when you open your new office, or educational events that people will find valuable. You could also reach out to different groups, or communities, and offer them a presentation on a topic that potential new clients would want to attend and then hopefully they will come to you when they are in need of your services.

You may also want to read my recent article, Can a Specialty Dentist Stand Out?

QUESTION: I was watching the hygiene scheduler video today and have a question. Regarding recall and past due recall, how would you handle a situation where some of these people that are past due and may have been erroneously placed on the “inactive” list but we’re not exactly sure what their status is, did they move, leave, or what?

ANSWER:  I would play dumb and call again, I hope you get my humor. I am sure that there are some on the list that actually wanted you to stop calling or have already informed the office that they are not coming back. Unless you know for sure, I would not want to assume that all of them that are inactive are that way for a reason, especially if you think some were put on there erroneously.

I would suggest that you discuss this with your team and make a plan to try to contact these people to double check if it was a mistake and then you can get them back or will know if they really don’t want to come back. I would then make sure to have one place that you all agree to put the notes, keep clear notes as to what happened in the call and highlight if they said that they were not coming back again so you don’t have to go through this next time. I would then make any patients that schedule, or any that said they are still planning to come back but don’t schedule now, active again with notes as to what was discussed in the conversation.

I would discuss with your team that they might need to have thicker skin during this process because they may encounter the occasional person upset over getting another phone call after already possibly telling your office in the past that they did not want to come back. Suggest that your team apologize in the nicest way possible and then let them know that clear notes will be made and that they will not be called again. It is worth more to have one or two people upset that your team called, than to lose out on the many more reactivations that potentially could have missed had you not called through the list to double check.

QUESTION:

I was watching the confirmation call video and you mention RevenueWell, which we also use. My question to you, what is your general opinion regarding automated appointment reminder systems? Is there a danger of relying on these too much? In other words, have these systems replaced phone calls and is there a danger that some offices may rely on them too much?

ANSWER:

Thank you for your questions – I have to tell you that I am so happy that you are watching the videos and learning, I wish more of my doctors were like you.

The first thing to address in answering your questions is the purpose behind a confirmation call, text or email. The purpose is not to “get the patients butt in the chair” (sorry if that is too blunt, but it is true). The main reason for this sort of connection with the patient is to get them to actually arrive to their appointment.

Every patient is different. Some patients write the appointment into their calendar and they will be there – you never have to remind them. Others, you need to call multiple times, email and text them the day of, to get them to show up. Therefore, there is not one set way that we should be doing confirmations. We need to customize these communications for the patients with the understanding that our purpose is to get them to show up to their appointment.

With that being said, yes, I would be concerned about relying too heavily on the use of automated systems too much. I think that having an automated system like RevenueWell is a great supplement to help us get the patients to arrive but needs to be combined with other things (such as phone calls) in order for it to work.

Again, it depends on the patient. I think that every office should have a set confirmation system in place but it needs to be customized and adapted as needed per patient.

I hope that answers your questions.

QUESTION: I am the office manager and need your advice on working as a team and not just with one person in the front office. I have an employee who tends to only want to work with one other employee and not as a whole team. When I am there covering, she never offers help – only when her preferred person is working the front. I always have to ask her to help or step in. Can you help me figure out how to get someone to help the entire team more?

QUESTION: We do a lot of financing in our office since most of our patients are uninsured. This includes CareCredit and in-house financing (tracked through Comprehensive Dental Finance). We also offer an in-house Dental Savers Plan for our uninsured patients. As a result, we have found this complicates each patient’s, account and it is not always straightforward figuring out balances owed. We are trying to streamline the post-treatment-plan acceptance phase where we enter and track the data about each individual’s balance and where it comes from so figuring out the amount owed before the patient arrives isn’t a project in forensic accounting. Do you have any recommendations for how to track these financial arrangements and monitor them on an ongoing basis? Our goal is that everyone at the front desk should be able to determine the amount owed for any given patient on the schedule after a minute or two of research max.

ANSWER:  That is a very hard question to answer because there are so many moving parts involved in the case acceptance process and the collecting of the balance… I have a few videos on this subject on the site which you definitely want to make sure your team watches, but also you might want to watch.

I am going to list out a few things that come to mind that I think are important to help you achieve what you are looking for:

1. Have a financial agreement with the patient that spells out what you offer and how they intend to pay. Make sure it gets filled out by your team, the patient signs it and then have it scanned into their chart. Always make sure to name it the same thing so everyone on the team knows what to look for when they need it.
2. Make sure your team is putting in excellent notes… Notes are so vital to making sure everyone on the team knows what is going on with the patient. We have our treatment coordinators print out the schedule each day and circle the appointments that they handled the treatment plan presentation as the day goes on. Before they leave at night, they have to make sure they have put in their consultation notes, to include the financial agreement information for the patient and the schedules are then turned into our Junior office manager, who reviews them the next day to make sure the arrangements are ok and that there are no red flags that need to be handled.
3. We have our insurance notes and our treatment plan notes in different colors so that when you are scanning notes, they are easy to see.
4. We try to keep our adult family members separated into different accounts so it does not get too confusing. Many times the kid’s accounts are not hard to figure out but the adult ones are the accounts that are confusing. They get more work done at larger amounts of money and if they are both getting the treatment done at the same time, it becomes hard to figure out the balance when their payments and the insurance payments are all coming in at different times for different procedures. It makes it much easier to have them separate because at least you know that you are narrowing down the balance for one of them specifically and not both.
5. We recently started outsourcing out insurance part of the practice which has helped a ton. We work now with a company called eAssist and they handle all of the insurance from submitting the insurance claim, to making sure that we get paid correctly and in a timely manner all the way through to entering the insurance checks and balancing the account. I was getting so frustrated with this area of the practice and decided to out-source it to them because this is their core competency and it allowed my employees to spend more time in the office with the patients and off the phone with insurance companies. They enter all the checks and call on all of our open claims and then put in notes that are in the exact same order each time with all the information my team needs to accurately discuss the balance with the patients. We are thrilled that we moved to this – let me know if you want information about them.
6. We do what I call “next day reviewer” and I teach on Front Office Rocks. Part of the problem about figuring out the balance is that the team waits until the day the patient has an appointment or sometimes even as the patient is walking up at the end of their appointment. That makes it very stressful for the employee and many times they just take a guess at where the balance is coming from. The patient ends up usually not thrilled with the answer and then leaves many times without paying because they tell the employee to let them know when they figure it out and they will pay then. As you know, it is better to get the patient to pay while they are in the office, versus letting them leave because the chance of that patient paying the bill goes way down and then patients come in sometimes for multiple visits without paying, which is never good. I would prefer that the team review all of the accounts the day prior to them coming in for two reasons: 1) it gives them time in a not stressful environment to review the account and figure out the balance and 2) it gives the employee time to call the insurance company if needed to find out status of an outstanding claim before the patient comes in. This allows the educated employee to be able to clearly talk with the patient about the balance which gives your office a much higher chance of collecting on that balance. Also, this employee that figures out the balance, needs to put in clear notes and the entire team needs to be trained at where those notes are so in case someone else checks the patient out, they can also inform the patient on what those notes say and collect.
7. The huddle is also huge in the process of getting your team on the same page. Every patient should be checked out by the front desk before they leave no matter what but there should be specific discussions with everyone on the team when a patient has a balance and that it is very important that the team brings them to the front desk so they have to collect on that balance.

I hope that this helped… if your office is anything like mine, there are different people in the accounts and so many moving parts… there definitely is not one right answer but with training and follow through to make sure the right systems are in place, this issue can definitely get under control.

QUESTION: Hi Laura. My question is this… We work Monday to Thursday. On Thursday we confirm patients for Monday, the system also sends a text the day before. Still we have a lot of cancellations and no shows on Mondays. What do you suggest?

ANSWER:  Thank you for the great question. Monday is a popular day for cancellations for sure, but it is not because of your confirmations – it is because the patient is not being held accountable. These patients would probably cancel even if you confirmed them on Friday.

I would change your thought process to targeting the patients and why are they cancelling.

• Are they college kids that can’t get up early after a weekend of fun – well don’t give them another appointment on a Monday
• Are they a patient that has cancelled a lot in the past – why keep rescheduling them – make them call for same day appointments in future
• Are they a patient that is not really great with their schedule – remind them when confirming them that this appointment is on Monday – after two days off – and make them commit that they will be there.
• Are they a patient in the schedule for treatment, make them put down a deposit or prepay for the appointment so they have the motivation to show up.
• Are they a patient that needs a last minute reminder, call them Monday morning and remind them of their appointment.
• Are they a patient that has cancelled a lot in the past and you only left them a confirmation voicemail on Thursday – call them again back on Friday and make sure in your messages you tell them they need to call back to confirm they are coming.

There are many reasons why patients try to cancel – so make sure you are addressing the patient and getting them re-trained not to cancel in the future, versus focusing too much on when you make the confirmation calls. I hope that this helps.

I am going to list out a few things that come to mind that I think are important to help you achieve what you are looking for:

1. ) Have a financial agreement with the patient that spells out what you offer and how they intend to pay. Make sure it gets filled out by your team, the patient signs it and then have it scanned into their chart. Always make sure to name it the same thing so everyone on the team knows what to look for when they need it.
2. ) Make sure your team is putting in excellent notes… Notes are so vital to making sure everyone on the team knows what is going on with the patient. We have our treatment coordinators print out the schedule each day and circle the appointments that they handled the treatment plan presentation as the day goes on. Before they leave at night, they have to make sure they have put in their consultation notes, to include the financial agreement information for the patient and the schedules are then turned into our Junior office manager, who reviews them the next day to make sure the arrangements are okay and that there are no red flags that need to be handled.
3. ) We have our insurance notes and our treatment plan notes in different colors so that when you are scanning notes, they are easy to see.
4. ) We try to keep our adult family members separated into different accounts so it does not get too confusing. Many times the kid’s accounts are not hard to figure out but the adult ones are the accounts that are confusing. They get more work done at larger amounts of money and if they are both getting the treatment done at the same time, it becomes hard to figure out the balance when their payments and the insurance payments are all coming in at different times for different procedures. It makes it much easier to have them separate because at least you know that you are narrowing down the balance for one of them specifically and not both.
5. ) We recently started outsourcing out insurance part of the practice which has helped a ton. We work now with a company called eAssist and they handle all of the insurance from submitting the insurance claim, to making sure that we get paid correctly and in a timely manner all the way through to entering the insurance checks and balancing the account. I was getting so frustrated with this area of the practice and decided to out-source it to them because this is their core competency and it allowed my employees to spend more time in the office with the patients and off the phone with insurance companies. They enter all the checks and call on all of our open claims and then put in notes that are in the exact same order each time with all the information my team needs to accurately discuss the balance with the patients. We are thrilled that we moved to this – let me know if you want information about them.
6. ) We do what I call “next day reviewer” and I teach on Front Office Rocks. Part of the problem about figuring out the balance is that the team waits until the day the patient has an appointment or sometimes even as the patient is walking up at the end of their appointment. That makes it very stressful for the employee and many times they just take a guess at where the balance is coming from. The patient ends up usually not thrilled with the answer and then leaves many times without paying because they tell the employee to let them know when they figure it out and they will pay then. As you know, it is better to get the patient to pay while they are in the office, versus letting them leave because the chance of that patient paying the bill goes way down and then patients come in sometimes for multiple visits without paying, which is never good. I would prefer that the team review all of the accounts the day prior to them coming in for two reasons: a) it gives them time in a not stressful environment to review the account and figure out the balance and; b) it gives the employee time to call the insurance company if needed to find out status of an outstanding claim before the patient comes in. This allows the educated employee to be able to clearly talk with the patient about the balance which gives your office a much higher chance of collecting on that balance. Also, this employee that figures out the balance, needs to put in clear notes and the entire team needs to be trained at where those notes are so in case someone else checks the patient out, they can also inform the patient on what those notes say and collect.
7. ) The huddle is also huge in the process of getting your team on the same page. Every patient should be checked out by the front desk before they leave no matter what but there should be specific discussions with everyone on the team when a patient has a balance and that it is very important that the team brings them to the front desk so they have to collect on that balance.

I hope that this helped… If your office is anything like mine, there are different people in the accounts and so many moving parts, there definitely is not one right answer but with training and follow through to make sure the right systems are in place, this issue can definitely get under control.

QUESTION: What types of marketing have you found to be effective in attracting new patients? Also, so you have a system to rotate pieces? I saw the accountability for new pt numbers on your goals and would like more information on what you do. Thank you.

QUESTION: Do you have a flow document and way to track it? Do you send pre-d on the same day as it was recommended or do you have one assigned day for handling them? What is the reason for selecting the way you are doing it?

ANSWER:  We don’t do too many predeterminations because it is our philosophy that no matter if the insurance says they will pay for a procedure or not, does not determine if the patient needs it. That being said, we do have some that go out. For example, if someone is considering a procedure that is more of an optional type procedure or something that they can wait for a decision on, such as implant.

We send predeterminations on the same day or the morning after the consultation. Typically our process is that to stage the predetermination in Eaglesoft, like the claims do when patients get walked out. That night all the notes are put in for the day which will help us with adding narrative for the procedures that need it and the predeterminations, to help get them approved. The next morning the appropriate information is added to the claims or predeterminations and they are sent to the insurance companies.

We then pull predeterminations on a report much like outstanding claims and call on them as we call on open claims. Once the predetermination is received by the office, the treatment coordinator then calls the patient with the information and attempts to get them scheduled.

On one other side note, we started working with a company called eAssist that handles all of our insurance entering and processing. I wanted to share this because their entire focus is handling all of our insurance issues in the office. There are two reasons that I love it:

1. ) it frees up my staff to focus on customer service and patient care and keeps them off the phones for hours with the insurance companies;
2. ) and they are paid a percentage on insurance collections per month, so they are motivated to keep the claims and payments current and do their best to get the maximum payment possible for our office and patients.

I used to have to pay one full time employee to do all of that and to me that seems like such a waste of talent for a great employee who could be helping in the office and with patient care.

Thanks again for the question…. hope that helps.

QUESTION: If after treatment is prescribed and presented to the patient, they still decide not to schedule, how should our office handle the phone call follow up and pursue case acceptance?

ANSWER:  I can tell you that as soon as the patient leaves your office, your opportunity to close them and schedule treatment goes down dramatically.

The idea of calling them regularly (3 times) after that is to get them to schedule but also to make sure they realize that the treatment they need is important and that you care about their health. If you allow the patient to leave and no one ever follows up, then the patient starts to wonder how important the treatment you suggested really is. If I had to estimate, I would say we probably still close about 25% of patients who left and did not schedule, but later scheduled over the phone. That being said, I believe the percentage goes up when patients come in for their next preventative appointment because they know from the calls that we are definitely concerned about their oral care and well-being. They may not have scheduled the treatment initially, but now they know it is something they need to get done.

QUESTION: I know my staff needs to make follow up calls for recare and unscheduled treatment, but it seems to be their least favorite thing to do and I do not think the staff is proficient at making the calls. How can I hire someone to successfully run these systems?

ANSWER: Your new hire should love talking on the phone, helping people and understand that it takes many phones calls to make significant progress and get through to the person they are trying to reach.

I would strongly suggest an individual, not in the dental industry, but someone from outside of dental who knows what it takes to get this type of job done. Then, make sure you have the system in place for the new employee and direct them to Front Office Rocks as their primary source of training, not the employee currently doing the job.

QUESTION: How do you guys do it for the financing part when it comes to the office fees? For example, if you sell a case for $3,680.00 and you put them on 18 months with no interest, but we have to pay the finance charge of $496.80… How can I charge more or charge the patient the finance fee? How does your office handle this?

ANSWER:  When we offer financing to our patients, we are doing it as a service to be able to help our patients get the treatment done. The idea behind offering financing options is to hope that we are closing cases that we might not have closed if we did not have these options and to not do in office payment plans, which ultimately turns our office into a bank, not a dental office. Therefore, for those reasons, I highly recommend that you offer finance options. I do however have a few thoughts specifically on offering them.

• You have to consider the fee you pay as a price of doing business. This fee is much like the fee we incur when we process credit card payments, however it is just higher. Again, you have to recognize it as a fee that you have to just be “okay” with in order to get this patient to do their treatment. More than likely, this patient would have not accepted this treatment if they had not had this option.
• You want to make sure your team is not using financing as a crutch to close cases. You want to make sure that your team offers financing as one of the payment options but does not “push” the financing as the best way to pay to the patient because many of your patients might opt to pay via check or credit card, which costs you less.
• I personally would not offer 18 months interest free financing in my office because it does cost so much. We limit our interest free financing to 12 months only and if they need to finance their payment longer than that, then they need to pay the interest.

QUESTION: We are looking for a good narrative for SRP. We have found that many of our claims to Delta Dental, although they tell us when we call for benefits, that they allow for all 4 quads in the same visit with documentation, then, deny it stating that they don’t find it necessary by consultant review. We only submit for SRP with probing depths over 4mm and we send the periodontal chart, the chart notes and x-rays. We often even submit with intraoral photos showing calculus build up and inflammation but they still seem to deny many of our claims for SRP to Delta Dental. We aren’t seeing that for all other insurance companies but want to make sure we are safeguarding ourselves. Please let us know if you have a great narrative that you can share with us.

ANSWER:  We certainly understand the frustrations with insurance companies and their propensity to deny claims. We must always remember the insurance belongs to the patient so we need to start by always letting the patient know we are doing the best for their dental health by providing the recommended treatment.

We will be happy to file their insurance claim for them but the insurance companies can and are in the business to deny claims whenever they can so if they have an issue with what the insurance company denies, etc. they should take it to their HR department for review. If the corporation/company providing the insurance to their employees complains enough to the insurance companies or threatens to leave that is the only time the insurance companies seem to sit up and take notice.

The 3 D’s with insurance companies are Delay, Decline & Deny. The most common mistake made when filing an insurance claim is the absence of information and attachments. Providing the wrong information can cause headaches, but also not providing the right amount of information can cause the same delay or denial. Also, providing the same, unvaried, or routine narrative for claims that are similar can also raise red flags to the insurance examiner so vary them each time they are sent especially when sending to the insurance carrier you are having issues with.

The narrative should always contain the periodontal condition that the patient presented with at their exam as well as the amount of time it has been since they were last seen in a dental office. Most carriers want also require the American Academy of Periodontology Case Type explained on the claim form as well.

Example: “Patient stated they have not been seen in a dental office or had any type of periodontal care since (Date/or approximate amount of time.) Patient presented with Case Type III-Moderate Periodontitis including generalized 4-6 mm periodontal probing depths, Bleeding on Probing, Mobility (state specific teeth if not generalized) exudate, (if present).”

Also mention the amount of deposits present and refer to intraoral photos for evidence of this, furcation involvement, missing teeth and recession. Always include a current FMX w/BWX or preferably VBX and periodontal charting showing comparisons, if available. As well, any other detail from the hygienist’s or doctor’s clinical notes and intraoral photos, if available.

Also, be sure you are up to date with the new code that has been introduced and available for use as of January 2017. Here is a link to the ADA site with more information.

QUESTION: How do you address cell phone use in the dental office? We have an employee in the back who is always texting on her phone. We have never had issue with this before. Just wondering the best way to deal with this.

ANSWER: We have a policy about cell phone usage/internet usage/taking breaks/etc., so there is no “gray area” in the office. Every team member reads the policies in the employee manual and signs it. This basically means “You told me the rules and the consequences if I break them. I fully understand your expectations”.

You may think some of these behaviors as just annoying or a nuisance, but they can be detrimental to your practice. If you allow one employee to bend the rules, the others will notice and then they will either follow suit or become resentful that the others are getting away with bad behavior which contributes to office drama that no one wants to deal with. Bad behaviors have a way of affecting everyone – all the way down the line to your patients.

Our suggestion would be to sit down with your team and explain to them what the rules are and what your expectations are. Discuss with your team the office policy on cell phone usage or any other “issue” you may be dealing with in the office. Ask for their input and if it is in line with your philosophy, put it in your office policy and have everyone sign off on it. This way they contributed to the policy and not only have more buy-in but also are all very aware of the rules and more importantly the consequences.

QUESTION: Help! 85% of our new patients show up either at their “appointment time” or even a few minutes late without their paperwork even filled out. Obviously this causes a slight amount of chaos in the office and also detracts from the new patient experience. We verbalize to the patient (multiple times) and it is spelled out in the new patient email (multiple times) we send the patient that they must arrive 10 minutes early for us to process their paperwork (if they’ve filled it out), and 20 minutes early if they have been unable to fill out their paperwork. Any tips or verbiage that you can offer that will help us better communicate this information to our patients, because we are missing the boat!

ANSWER: Thank you for your question and I’m sorry you’re having this issue. Unfortunately, this is typical in most dental offices. I have two suggestions for you:

• Since the patients aren’t coming in early to fill out their paperwork or if they are hearing you ask them to come early but not finding it to be important, my suggestion is you confirm the appointment time with the patient for 15 minutes before the actual appointment. Train your team when they are offering an appointment to offer an appointment 15 minutes before you actually want to see them. So if the new patient appointment starts at two, have your team offer a 1:45 appointment time.
• Consider moving to online new patient paperwork. That is what we have done. We’ve recently started working with a company called Yapi in order to become fully paperless in our office. We now have our forms online that we direct our patients to fill out, so we can import all of their information into EagleSoft before they even arrive.

It’s always a good idea to have the doctor review the lab cases when they come into the office in case he finds something he wants to change, then you have time to reschedule the patient if necessary.

The problem with most practices is that there is no set protocol or best practices in place and no one person responsible managing and documenting lab cases as the cases go out to the lab and return to the practice.

Below are a few ideas you can implement to help:

1. Utilize your dental practice management software – Most if not all software programs have the ability to track lab cases as they leave and return to the office. This is the simplest way to track but just the first step.
2. Document, Document, Document! – The dental assistant should be responsible for documenting the lab case from preparation, writing up the lab slip, packing for delivery, all the way to reaching out to the lab for delivery date and make copious notes in the patient’s chart. The front desk coordinator or other designated front office team member should be responsible for entering the lab case into the practice management software in the patient’s record, including those leave and return dates. The front desk is also responsible for scheduling the patient’s follow-up appointment and allowing the correct amount of time to process the case.
3. Responsibility – As mentioned above with documentation, it is extremely important to have two people assigned to monitor these cases so that if by chance one of them is out or there is a question they have the other one as fall back. Their responsibilities can vary as every practice has different ways of handling tasks in the office but as long as all of these are covered you shouldn’t lose track of cases.
4. Check cases days in advance – Have one of them also check the cases days before the patient is scheduled in case there are any issues that would involve rescheduling the patient. You should be able to review the schedule or print out a list of cases that are due from your software if entered correctly and being well prepared in advance will allow the case to be tracked down and resolve any issues before the patient is involved. Another time to make sure if the lab case is in is before confirmation calls. If for some reason it wasn’t in days in advance or was overlooked, prior to making the confirmation call, double check that the case is in.
5. Plan B – If a patient arrives for their appointment and for some reason the above protocol wasn’t followed and you realize the case is not at the office. Don’t panic – especially in front of the patient. If a patient sees that you are not confident and in charge of the situation, you could upset the patient for no reason and possibly lose their trust in your office.

If there is a screw-up, I also think you need to go back and see where the ball got dropped. Was there a step that fell out? Did someone drop the ball? This is not necessarily to find blame but to learn from the mistake, possibly get the system fixed or the person trained so it does not happen again.